Many oncologists not on top of managing pain: study
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NEW YORK (Reuters Health) - In new survey of cancer doctors in the U.S., many oncologists said they were good at managing their patients' pain -- but most failed to choose the right treatment option in a test, and said that figuring out how much pain patients have is still a major barrier to providing appropriate care.
The study is a follow-up to a similar survey that found a lack of good pain management practices in U.S. oncologists in 1990 -- and it shows that more work needs to be done to educate doctors about pain, researchers said.
"When patients come to see their oncologists, they're wondering often, 'Am I going to die from this? What is the size of the tumor the doctor's going to palpate?'" said Dr. Neil Hagen, the head of palliative medicine at Alberta Health Services Cancer Care in Calgary, Canada, who didn't participate in the new research.
"In that scenario it's so easy for pain and symptoms to take second place to the cancer treatment."
Still, Hagen told Reuters Health, "It's really important to manage pain better, and it's okay to talk about it."
A total of 610 of 2,000 oncologists who were sent the surveys on how they handled cancer pain responded, including doctors at comprehensive cancer centers, community and teaching hospitals, and those with outpatient offices.
On average, doctors rated their own ability to manage pain at 7 on a zero to 10 scale, but said other oncologists were generally more conservative in their treatment. They rated their own education on pain management during medical school and residency as okay, at best.
The survey also included two common scenarios, invented by the study's authors, about a patient who's in pain despite being on a relatively high dose of strong painkillers called opioids. Oncologists were asked if they would increase the dose of the painkiller, switch to a different medication or add a new drug on top of the original one.
The right answers, according to pain specialists, included adding on fast-acting drugs to the initial medication regimen or making small increases in the daily dose of the original drug.
Most doctors missed the correct answers -- 60 percent on one of the scenarios and 87 percent on the other question that required oncologists to explain why a steep increase in opioid dose would be dangerous.
Oncologists did generally agree that opioids, including morphine and oxycodone, should be the first choice for treatment of chronic cancer pain and are better used in regular doses than only when needed, researchers reported in the Journal of Clinical Oncology.
The doctors also said that patients' reluctance to report pain and to take strong painkillers were barriers to giving appropriate care -- but few referred patients regularly to pain specialists.
Study author Brenda Breuer, from the Beth Israel Medical Center in New York, said the findings point to a need for medical schools and residency programs to do a better job of preparing future oncologists to manage pain.
And they have implications for cancer patients themselves, who should speak up about their pain, she added.
"I think that the takeaway message is to know that there are specialists in pain medicine and palliative care medicine," Breuer told Reuters Health. "They should not be afraid to request consults for managing pain."
Dr. Jeff Myers, head of the palliative care consult team at Odette Cancer Center, Sunnybrook Health Sciences Center in Toronto, Canada agreed that patients shouldn't be quiet about their pain.
"When you're talking about a very busy clinic with a massive number of patients, the focus of the oncologists in many ways must be on what's happening with the specific cancer," he told Reuters Health.
"I think that the answer is not so much how to change the physician's perception or perhaps change the practice, I think the bigger issue is to make sure to educate and inform patients and empower them," said Myers, who wasn't involved in the new study.
He added that nurses and other hospital staff could get on board with regularly screening patients for pain symptoms.
"Just because you have cancer doesn't mean you're supposed to be in pain," Myers said.
SOURCE: http://bit.ly/gPtMdm Journal of Clinical Oncology, online November 14, 2011.